ABSTRACT
In modern diagnostics, it is extremely important to maintain and ensure quality of laboratory results dispatched. It is part of the total quality management and an essential criterion for accreditation of the laboratory. The analysis of biochemistry samples can be broadly divided into three phases: pre-analytical, analytical and post-analytical phase. We wanted to identify the commonly occurring pre-analytical errors and determine the turnaround time in the emergency biochemistry laboratory at a tertiary care hospital in Delhi.METHODSA cross-sectional study was done on a total of 2,73,111 samples received in the emergency biochemistry laboratory from September 2018 to August 2019 and an analysis of occurrence of pre-analytical errors was done, retrospectively. Additionally, the turnaround time of the laboratory was evaluated over a period of two months from July 2019 to August 2019 and average time was recorded. Data was collected from entry registers and rejected samples registers.RESULTSIn this study it was found that 10.58 % of the total samples received were rejected. Moreover, overall turnaround time was found to be 108 minutes (median value). In the present study, haemolysis was the most common reason for sample rejection. (63.14% of total rejections). Additionally, the second most common error was inadequate samples. 6570 samples were rejected due to this reason (22.73%).CONCLUSIONSHaemolysis was the most common cause of rejection in the emergency biochemistry laboratory. Also, it was seen that the most time-consuming step was analysis in auto-analyser with respect to contribution to turnaround time. As a matter of fact, Pre-analytical errors can adversely affect the treatment of patients. However, most of the errors can be reduced by proper training of the staff and checking competency thoroughly by conduction of practical and theory assessment of laboratory personnel at frequent intervals
ABSTRACT
One of the important functions of a clinical biochemistry laboratory is clear, accurate, and rapid communication of a critical value to clinicians1. Critical value reporting is one of the requirements for laboratory accreditation. This study aimed to analyse the critical values data at a tertiary care hospital in New Delhi, India in the emergency laboratory setting and compare it with the available data from previous studies.METHODSThis is a retrospective study of emergency biochemistry samples done over a period of two months from July 2019 to September 2019. The critical values data of several biochemical parameters generated from the testing of samples on Beckman Coulter Olympus AU 480 during three months period were analysed. Statistical analysis was conducted using Microsoft Excel 2016 program.RESULTS183056 tests were analysed, and 11875 critical alerts were generated the incidence of which varied from 0.8% for glucose (children) to 10.6% for serum potassium in children. Frequency of critical values for serum potassium is highest followed by serum sodium. Also, critical values for serum potassium in paediatric patients is higher than in adults. It can be stated that there is a need to study of frequency of critical values in emergency as well as routine laboratories to identify the parameters with maximum critical values and also recognize the underlying causes for the same and take suitable measures.CONCLUSIONSThe frequency of critical value for serum potassium, is highest followed by serum sodium, in case of samples received from adult patients. Also, frequency of critical values for serum potassium in paediatric patients is even higher than adults. These values show that these critical biochemical values can be detrimental to these patients and timely notification to the clinician is very important so that necessary actions could be taken to correct them. Further studies of critical values in emergency labs is required to observe trends and identify the underlying causes and suggest suitable remedial measures if any.
ABSTRACT
Recent studies suggest a cause and effect relationship between eNOS gene polymorphism and increased incidence of insulin resistance as NO deficiency is associated with decreased vasodilation and altered binding of insulin to insulin receptor. Current studies suggest a worldwide association between eNOS-786T/C gene polymorphism and genetic susceptibility to insulin resistance. We wanted to study eNOS -786T/C gene polymorphism, nitric oxide and insulin Resistance in patients with CAD in Indian population.METHODSThis study consisted of 60 cases who were adult patients with documented coronary artery disease. 60 age and sex matched healthy subjects were selected as controls. In these groups, fasting serum insulin was measured by ELISA, fasting serum nitric oxide by modified Griess reaction and fasting plasma glucose on fully automated chemistry analyser (Hitachi 902). Furthermore, HOMA-IR was calculated mathematically. The eNOS gene loci was amplified by using PCR and by RFLP. A p-value <0.05 was considered significant. Statistical analysis was performed with SPSS.RESULTSThe mean serum NO levels were very significantly lower in case groups and mean HOMA-IR levels in the study group were significantly higher as compared to the control group (p=0.000) suggesting the role of insulin resistance in CAD. The frequency of Tallele was 76.67% in the study group and 81.67% in the control group while the frequency of Callele was 23.33% in the study group and 18.33% in the control group respectively. This difference was found to be statistically significant (p=0.0123).CONCLUSIONSEndothelial Nitric Oxide Synthase (T786C) gene polymorphism, is significantly associated with occurrence of coronary artery disease. Thus, this polymorphism could be a potential risk factor for development of coronary artery disease in adult Indian population.
ABSTRACT
Haemolysis is the most common pre-analytical error encountered in biochemistry laboratories. Several clinical biochemistry laboratories have adopted individual policies regarding rejection of haemolysed samples. The aim of this study was to evaluate the effect of visible haemolysis on biochemistry parameters done in the emergency laboratory.METHODS150 blood samples (50 highly haemolysed, 50 slightly haemolysed and 50 no haemolysis) that were received in the Emergency Biochemistry laboratory of Safdarjung Hospital, New Delhi, were included in the current study. They were analysed for different biochemical parameters and the results compared. Statistical analysis was conducted using Microsoft Excel 2016. Data was presented as, number and median. Mann-U Whitney test was used to test any significant difference between the groups. p< 0.05 was considered to be significant.RESULTSNo significant change was seen in samples with slight haemolysis. However, values of potassium, total and direct bilirubin were significantly elevated (p-value-0.001, 0.002 and 0.015 respectively). Moreover, mean ALP was found to be 290±19.76 U/L in slightly haemolysed samples and 211±16.67 U/L in samples that are highly haemolysed (p=0.049). Therefore, there was a heterogeneous and unpredictable response to haemolysis observed for several parameters that prevents the adoption of reliable corrective measures for results on the basis of the visible haemolysis.CONCLUSIONSThe test values of slightly haemolysed samples can be reported as there is little interference seen. However, in case of highly haemolysed samples, values of ALP, potassium, total, and direct bilirubin should not be reported. Nevertheless, visual assessment is not a reliable method to identify haemolysis, free haemoglobin concentrations should be measured.